Called to Care, Trusted to Teach: The Role of Hospital Chaplain in Educating Patients, Families, and Medical Staff during a Pandemic

ELECTRONIC JOURNAL FOR RESEARCH
IN SCIENCE & MATHEMATICS EDUCATION
VOL. 25, NO. 3, 83-88

Called to Care, Trusted to Teach: The Role of Hospital Chaplain in
Educating Patients, Families, and Medical Staff during a Pandemic
Rev. Casey Bien-Aimé
Lankenau Medical Center

Rev. Kristel Clayville
University of Illinois at Chicago

 ABSTRACT

 The theory and practice of spiritual care has transformed over the years. Chaplains have broadened
 the definitions of their work, formalized spiritual assessments, and gained greater understanding of
 multi-faith and interfaith support. In 2020, the COVID-19 pandemic forced a new shift in thinking
 specifically causing many healthcare chaplains to add technology and phone support to their
 practice. Spiritual care was offered by telephone, video application, recorded religious services, and
 many other creative/socially distanced interventions. Chaplains are trained to adapt. They quickly
 formed support networks, shared their ideas and plans, and built a new foundation to withstand
 new issues that arose in 2020. In this article, we describe how chaplains were able to pivot quickly
 into new aspects of their role, teaching and learning from other spiritual care communities across
 the country, and how they have been called upon to educate their healthcare communities in a new
 landscape created by the pandemic.

Keywords: science and religion, chaplaincy, COVID, pandemic, spiritual care,

                                                 Editors’ Comment

Rev. Casey Bien-Aimé (2019-2021 Fellow) is the Spiritual Care Coordinator and Endowed Chair of Pastoral
Care at Lankenau Medical Center where she brings awareness to the importance of incorporating spirituality in
healthcare. Rev. Kristel Clayville, Ph.D., (2019-2021 Fellow) holds a doctorate in Religious Ethics from the
University of Chicago’s Divinity School and is ordained in the Christian Church, Disciples of Christ. Throughout the
COVID-19 pandemic, she served as a chaplain and ethicist at the University of Chicago Medical Center with a focus
on the existential and spiritual issues facing organ transplant patients. In this contribution, they share how their
challenges in bridging the communication gap between doctors, patients, families, hospital staff, and other healthcare
advocates and how their methods of care and communication had to change due to the COVID-19 pandemic. While
hospital chaplaincy looks quite different from traditional K-16 science education, we think the ways they adapted to the
difficult times of the pandemic can resonate with reflects and may inform the changes required of science educators as well.

                                                     Introduction

         The theory and practice of spiritual care has transformed over the years, especially as hospital
chaplains integrated into interdisciplinary medical teams. Chaplains have broadened the definitions of
their work, formalized spiritual assessments, and gained greater understanding of multi-faith and
interfaith support. In 2020, the COVID-19 pandemic forced yet another shift in thinking about how

© 2021 International Consortium for Research in Science & Mathematics Education (ICRSME)

84   BIEN-AIMÉ & CLAYVILLE

to support patients in isolation and how to connect families to their loved ones. Many healthcare
chaplains added technology and phone support to their practice. Spiritual care was offered via
telephone, video application, recorded religious services, and many other creative socially distanced
interventions. Chaplains are trained to adapt. They quickly formed support networks, shared their
ideas and plans, and built a new foundation to withstand the new challenges that arose in 2020. While
many still associate the term chaplain and even spiritual care with Christianity; professional chaplains
serve in an interfaith/multifaith capacity. We serve all members of our community, those who identify
with a formal faith tradition and those who do not. We help patients, families, and staff connect to
what gives them strength and hope and help them make meaning from uncertainty. As chaplains we
visualize ourselves as standing in the gap between patients and their medical team, between family
members in disagreement, and between our hospitals and the communities we serve. Many of us
helped with communication when patients and doctors seemed to be speaking two different languages.
This kind of communication work is foundational to the role of the chaplain and to the functioning
of hospitals. The pandemic brought about changes in clinical practice that created opportunities to
educate and to further be the bridges that connected different value systems. In this article, we outline
how chaplains pivoted quickly into new aspects of their role and how they have been called upon to
educate their healthcare communities in a new landscape created by the pandemic. We will focus on
the chaplain’s communication with four different groups: patients and families, medical teams,
hospital operations, and the broader community.

                        Initial Impacts of the Pandemic on Spiritual Care

         On March 13, 2020, hospitals all over the country learned that the virus we had heard about
and feared, had officially caused a global pandemic. Hospital teams had been hearing murmurings of
the novel virus and its impact in other countries, and even how it was affecting our Pacific coast
colleagues, but with the CDC officially declaring this a pandemic, many of our hospitals changed their
practices and shifted to new methods of giving care.
         The chaplains at hospitals caring for COVID positive patients, in the early days of the
pandemic, were navigating many changes, both in how we would practice and the rules the hospitals
would follow. Due to limited PPE and overall uncertainty about how this novel virus spread, at first
many chaplains were not permitted in the rooms of our COVID patients. We found new ways to
support families over the phone, and to offer meaningful rituals from doorways and windows.
Chaplains educated the medical teams on the go. There was limited time for didactics and
presentations at nursing huddles. We explained our practices as we did them. We charted clearly. We
updated policies posted online and in the nursing units. The question everyone in the hospital was
asking was, “Am I considered essential staff?” For chaplains, the answer was not straightforward.
         While a chaplain is not providing support for physical/medical needs of our patients, our role
has remained crucial during the pandemic. A chaplain’s work is often in person and physically close.
We sit in rooms, offering listening, conversation, ritual, and prayer. Our practices can have extended
periods of silence, and our rituals and prayers often involve touch and closeness. The way chaplains
practice was completely upended with the guidelines we would need to follow during the pandemic.
Touch was off the table. Long encounters increased risk of contracting or spreading the virus. When
staff received communications about possible exposure, we were asked if we had worn our PPE, stood
six feet away, and if we were in the room longer than 15 minutes. Chaplains and spiritual care
professionals at the beginning of the pandemic had to continually update our roles and responsibilities
to adapt their practice for the health and safety of the communities we served. Our first major change
in our practice centered around communication, particularly communicating to patients and their
families.

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                     Communication with Patients and Families: Tele-Chaplaincy

          The chaplain stands in a room, gowned, gloved, masked, and shielded. He is holding an iPad. He sometimes
props the iPad on the tray table to give his arm a rest, as the family sings hymns, reads scripture, and prays for their
mother lying in the bed. On the days that she is more alert, he holds the iPad for her, so she can mouth her responses to
her family. He brings the iPad close to her so they can hear her better over the beeping machines and general noises in
the hallway. Occasionally they ask the chaplain to pray, or help read her lips, when her voice is too weak. But mostly,
they forget that someone else is in the room. In these precious moments it is just mother and children, looking into each
other’s eyes, listening to each other’s voices, longing to be in the same room again.
          Traditionally, chaplains provide support to families of hospitalized patients. Many hospitals
stopped visitation altogether, and those who did not, severely restricted it to short visits, and often
only at end of life. With many of our patients intubated or on breathing treatments, out of breath,
tired, or even prone in bed, our time spent at bedside was now split with time calling families who
longed to be present with their loved ones.
          In a profession where eye contact, silence, and body language are major parts of our tool kit,
offering presence and support over the phone became a challenge for many. Chaplains had to translate
their usual skillset to phone and video calls with family. One of the first areas to adjust was our opening
lines and scripting. Families receiving calls from hospital extensions were answering with fear and
anxiety. In our typical conversations we would have time to explain our work and communicate our
role – with phone calls, we were battling with the loved one’s fear that a call was coming to report bad
news. We began our calls with words like, non-urgent and routine. We centered ourselves before calls,
making sure we were calling from a quiet place, where we were not out of breath, rushed, and where
we could communicate calmly through the phone lines. We learned how to narrate the silence. Where
we could usually communicate our comfort with silence through our bodies, we had to explain the
silence with words, saying things like, “I hear the silence in our conversation. I’m giving space in our pauses so
you have time to process and think. I am not in any rush. But if the silence is uncomfortable or you are silent because
you don’t want to talk about this over the phone, we don’t have to continue this conversation here.” Our closings also
had to be clearer and more deliberate. Where we would normally say, “Have your nurse page us.” We
now had to encourage them to write down our contact information (and to have other departments’
contact information available as they often asked us for assistance in navigating communication with
so many departments serving remotely). While this has not been the way we like to practice our calling,
chaplains have added these and many other tools to our presence tool kid, allowing us to better serve
those who need to use the phone or video applications to connect to us.
          For those chaplains who were given permission to get N95s and use additional PPE, our role
as tech support increased greatly during pandemic. Many of us walked around with phones and tablets
that used applications like Facetime, Zoom, and Doximity. We helped families celebrate birthdays,
view or plan funerals and memorial services, and facilitated family meetings and interdisciplinary calls.
Spiritual care departments partnered heavily with information technology and audio-visual
departments. We trained on different operating systems so we could support the nurses and other
staff who were also using the technology more than ever before. Even chaplains who identified as
technology natives were stretched thin, trying to educate patients, families, and staff on the new
technology that was not an everyday part of their lives.

Communication with Medical Teams: Notes as a Form of Education

          A palliative care team is beginning their day by discussing their list of patients. The list is three times its normal
length – small print on multiple pages. Symbols and highlighter marks on each page help organize their day, with bold
letters noting which patients are COVID positive. The chaplain peaks her head in the door and apologizes that she

86    BIEN-AIMÉ & CLAYVILLE

can’t sit in on the team meeting, that she is running to the Emergency Department for a trauma. They lament together
as they think about how devastating it is to watch so many die and be debilitated by the virus on top of the regular
trauma, illness, and loss seen in the hospital. The chaplain reminds them to check her notes as she runs out the door.
As the team runs the list and meets with family (in meetings or by phone) they check the chaplain’s notes to assure them
of the chaplain’s presence. “Yes, ma’am, I see the chaplain’s note. The priest gave your mother Last Rites last night.”
“I’ll put in a request with the chaplain to read that poem to your husband.” “I see a note here that the chaplain posted
pictures of you and your son in the room, with quotes from his favorite movie to inspire him. Is there anything else you’d
like from their team?”
          With the use of the electronic medical record (EMR), reading interdisciplinary notes has never
been easier. For Spiritual Care departments who use these charting systems, our notes have become
more visible and a great way to educate staff about our role. At the height of the pandemic, the days
often felt like a blur. With multiple deaths a day, countless family meetings, and a long list of phone
calls to make, chaplains were not able to do the in-person conversations with our nursing teams.
Where we would once round with the medical team, or chat after nursing huddles, many chaplains
found ourselves having to trust that the note was being read and our work was being seen in black
and white on the screen.
          We have used Spiritual Assessments to clarify how we are supporting patients and families.
Dr. Gowri Anandarajah (2005) defines Spiritual Assessment as “methods to identify a patient's
spiritual suffering and spiritual needs related to medical care” (p. 372). It takes many forms, with a
variety of acronyms used to delineate the questions and conversations between spiritual care
professionals and the patient/family we are serving. We assess faith tradition, connection to
community, rituals and practices that bring healing, and how the team can support those healing
practices. These succinct, yet detailed notes were ways of educating the team on what spiritual care
does in general and in light of the virus.

 Communication with Hospital Operations: Collaboration with Infection Prevention about
                              Rituals in the Hospital

           On March 6, 2019, a chaplain is seen standing outside the hospital’s prayer/meditation room. She is wearing
a clerical collar and holding a small container of ashes. It is Ash Wednesday, a holiday on the Christian calendar that
begins the season of Lent when many will attend services, start a form of fasting, and have an ash cross on their forehead.
For hospital chaplains that serve large Christian populations, it can be one of their busiest days of the year. Wearing a
glove on her right hand, she dips her thumb in the ash, marks the head of the person in front of her, and offers a prayer.
Some of the staff and families make special prayer requests, some cry and hug the chaplain, many thank her, citing that
their 12-hour shift always prevents them from attending their religious services.
           Fast forward to February 26, 2020 – that same chaplain now looks very different. She now wears scrubs and
sneakers. She has a bottle of hand sanitizer in her pocket and a bag of pre-ashed cotton swabs in a canvas bag. Cards
with special Ash Wednesday prayers are laminated and placed in plastic baggies. Staff are not permitted to line up at
the hospital’s prayer room. Instead, the chaplain schedules times to visit each unit. Directs staff not to congregate at the
nursing station and to keep distance. Those who want the chaplain to administer the ashes stay distanced for the prayer,
they move together as the chaplain sanitizes her hands, removes a cotton swab from one of her many bags, dips it in the
ash, marks the staff person’s forehead, and discards the used swab in a bag marked for incineration. Some staff ask for
the pre-bagged ash swabs to self-administer, others ask for the baggies in order to bring this blessing to isolated family
members at home. Honoring this ritual always made for a long day, but now, the process needed to keep her community
safe, makes her day even longer and more complicated. With months of preparation, countless emails with administration
and leadership, meetings and discussions about emotional needs and physical risks, and finally a week of late-night
bagging and preparing the materials. The chaplain completes this one-day ritual exhausted but honored to give some
semblance of normalcy to an emotionally and physically exhausted community.

CALLED TO CARE, TRUSTED TO TEACH                              87

         Hospitals are known for their celebration weeks: nurses week, spiritual care week, hospital
week, and many more. These are opportunities to educate the hospital community about the services
provided by these professionals, but also a time to thank and support the professionals in those fields.
Nurses week 2020 was celebrated May 6th through the 12th. Hospitals were at a loss for how to
acknowledge the week. The awards and dinners could not be in person. The meals and treats couldn’t
be eaten together. And for the chaplain collaboration, the blessing of the hands, had to be completely
re-thought. In the past, chaplains would round the hospital with oil or holy water, sometimes with a
ritual including small wooden hearts, ribbons or colored paper. Chaplains would greet the medical
teams, hold their hands, and bless them. The ritual was always moving, and sacred. But how do you
offer this intimate blessing from six feet apart?
         Chaplains had to collaborate with Infection Prevention (IP) at our hospitals to ensure any
practice they offered was safe. To facilitate these conversations, chaplains would provide a range of
options to the IP team. Often having to explain the history and background of the rituals. Each
spiritual care department has their own philosophy of spiritual care. For departments that utilize a
multi-faith approach, many holidays are honored - often depending upon the patient population
served by the hospital. Chaplains find creative ways to help patient’s honor their holiday while being
mindful of the restrictions and limitations of being in the hospital. For Ash Wednesday, a holiday
honored by many Christian denominations, chaplains will often collaborate with the community to
distribute ashes to staff and patients who are unable to make it to their respective faith community.
For Passover, the chaplains have assembled and distributed bags of Kosher for Passover treats, and a
Kosher for Passover menu for the Jewish patients. During the month of Ramadan, some chaplains would
deliver date bars and blessings for Muslim staff and patients to break their fast at the end of the day.
These are just the tip of the iceberg when it comes to honoring local faith traditions, especially in
hospitals that serve diverse communities. For chaplains who practiced this multi-faith approach, each
holiday practice had to be re-evaluated by the department and approved by the IP team and the
command center. With each holiday and ritual, the administrators making the decision needed to be
educated about the significance and importance for patients. Often decisions were changed, edited,
and debated many times before approval.

         Communication with the Broader Community: Educating Community Clergy

          On March 10, 2021, a hospital system honored the one-year mark of their first COVID + patient and the
hundreds of patients who had died that year. On that same day a local church was offering second doses of the Pfizer
vaccine to their community. As socially distanced patients sat in folding chairs in their parish hall, the local hospital
chaplain dropped off prayers for the vaccine and knitted hearts for the medical professionals. The pastor of that church
offered a prayer, as the vaccine distribution team played a streamed service over their laptops. With tears in their eyes,
and hope in their hearts, the congregation and community were able to hold both their hopes and fears at the same time.
With pastors, chaplains, and medical professionals working together, the community was given space to process the
complexity of emotions that came with a year of quarantine and immense grief.
          The education provided by chaplains was multi-directional. While chaplains often are used to
train medical professionals and hospital administrators about religious and cultural needs, they also
help connect with the community, particularly local faith communities, to educate local clergy and
faith leaders. Chaplains serve on interfaith councils, ministeriums, and town councils. Many religious
leaders have routines of reaching out to sick and hospitalized congregants and community members.
With the pandemic, many hospitals limited or even completely restricted these visitations. Such
restrictions forced chaplains to be even more mindful of the broad approach and understanding of
diverse religious practices and rituals. While some clergy were able to use zoom and facetime to
connect with their congregants, many relied on chaplains to offer the rituals expected by their
parishioners.

88    BIEN-AIMÉ & CLAYVILLE

        As vaccines began to roll out, chaplains served on vaccine confidence committees and helped
support community vaccination sites. They offered written and extemporaneous prayers for those
receiving the vaccine. They bridged the gap between the medical/scientific community and the
religious/spiritual. As healthcare chaplains look ahead, we hope to continue to care for our local
communities to offer grace and guidance to navigate the complexity of spiritual and physical health.

                                                    Conclusion

        One of the foundations of spiritual care education is communication; specifically, our ability
to understand what is going on with ourselves, and to help share those understandings with and
between others. Because of this internal work, spiritual care professionals have anticipated and
weathered change well. Whether supporting the changes in a patient’s life or bearing witness to the
changes in the healthcare landscape, a chaplain acknowledges the many transformative moments faced
in the hospital. Because of the training and skills of chaplains, this profession created new ways to
support their sites, in a time of uncertainty. They created and re-created in the face of changing rules
and roles.
        Communication is key to the practice of spiritual care. We communicate about difficult topics;
one's deep feelings, existential thoughts, conversations around death and dying, and much more.
When the pandemic hit, chaplains used that foundation of communication to build, grow, and reform
their own practices to better serve their communities. There was no one way to be a chaplain in a
pandemic, but what united spiritual care professionals across the world in 2020, was the ability to
adapt and educate as we went. We hope to never face a pandemic or disaster of this magnitude ever
again, but if we do, the chaplains are ready to tend, transform, and teach through whatever comes our
way.

The authors received no financial support for the research, authorship, and/or publication of this manuscript.

Rev. Casey Bien-Aimé (Bien-AimeC@mlhs.org) is ordained in the American Baptist denomination,
endorsed and commissioned as a chaplain from her ordaining body. She received her undergraduate
degree in Religious Studies/Biology at Drew University, her seminary training at Palmer Theological
seminary, and Clinical Pastoral Education at Thomas Jefferson University Hospital. She has served as
the Spiritual Care Coordinator at Lankenau Medical Center since 2015, where she has helped build
the Spiritual Care Department. Rev. Bien-Aimé has a passion for interfaith work and interprofessional
dialogue that has fueled many collaborative efforts within her health system and community.

Rev. Kristel Clayville, Ph.D., (kclayvil@uic.edu) is ordained in the Disciples of Christ denomination,
and served as a hospital chaplain during much of the pandemic. She received her masters, doctoral,
and fellowship training at the University of Chicago, and completed Clinical Pastoral Education at
Northwestern University Memorial Hospital. Currently, she spends most of her time teaching
technology ethics in the College of Engineering at the University of Illinois at Chicago, where she also
teaches religion and medicine in the medical school.

                                                    References

Anandarajah, G. (2005). Doing a culturally sensitive spiritual assessment: Recognizing spiritual
      themes and using the HOPE questions. AMA Journal of Ethics, 7(5), 371-374.
      doi:10.1001/virtualmentor.2005.7.5.cprl1-0505